Health inspection·May 22, 2025

F 0550 8:03 PM: The resident was in a wheelchair in the hall, speaking with an unknown person . Level of Harm - Minimal harm or potential for actual harm 8:05 PM: The resident was in a wheelchair in the hall speaking with an unknown person, asking for a staff member. Residents Affected - Few 8:26 PM: Resident returned to her room via her wheelchair. 8:28 PM: The resident could be heard speaking to an unknown individual via the camera. 8:33 PM: CNA G left Resident #36's room across the hall and entered the room to assist Resident #36. During an interview on 05/21/25 at 09:06 AM, Resident #36 said the CNA who did not help her off the toilet on 04/29/25 still worked at the facility, and the only action the facility took was to reassign the CNA to a different hall. During an interview on 05/21/25 at 2:36 PM, CNA G said she left Resident #36 on the toilet and did not return because she was assisting another resident. She said Resident #36 could get off the toilet herself and required minimal assistance. She said she previously had spoken to the resident, and they decided to schedule her bedtime for 8:30 PM, so she proceeded to give a shower and provide incontinent care to the residents across the hall. She said after she finished incontinent care, she returned to assist Resident# 36. 2. Record review of Resident #86's, undated, face sheet, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Her diagnoses included Dementia (the loss of cognitive functioning to such an extent that it interferes with a person's daily life and activities), and Depression (a mental health condition characterized by persistent feelings of sadness and loss of interest or pleasure in activities). Record review of Resident #86's Quarterly MDS Assessment, dated 04/22/25, reflected she had a BIMS score of 05, which indicated severe cognitive impairment. The resident required substantial/maximal assistance with toileting and showering. Record review of Resident #86's revised care plan, dated 03/29/25 , reflected Resident #86 had an ADL self-care performance deficit related to her disease process and was resistive to care and could be combative related to dementia. Her interventions included allowing the resident to make decisions about the treatment regime, providing sense of control and educating resident/family/caregivers of the possible outcome(s) of not complying with treatment or care. Observation video footage, dated 05/02/25, revealed: 8:42 AM: The resident was lying in bed and CNA M tried to get resident up and out of bed. 8:43 AM: Resident #86 could be seen resisting and telling LVN R and CNA M to leave her alone. Staff continued to assist the resident out of bed, and she was then placed in the wheelchair. During an interview on 05/22/25 at 9:22 AM, CNA M said if a resident refused a shower, she would leave the resident alone and notify the nurse. She said the resident had the right to refuse. She said the resident may experience a negative outcome if they refused care, but the staff proceeded (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676333 If continuation sheet Page 2 of 8 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676333 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Magnolia Crossing Nursing and Rehabilitation Cente 10800 Flora Mae Meadows Rd Houston, TX 77089 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0550 because it would be a violation of their rights. Level of Harm - Minimal harm or potential for actual harm During an interview on 05/22/25 at 9:45 AM, the interim DON said residents had a right to refuse care. She also said Resident #86 should have received assistance from the staff after toileting. Residents Affected - Few During an interview on 05/22/24 at 1:44 PM, the ADON said all residents had a right to refuse care, and her expectation was for staff to notify the RP of the refusal and document it in the electronic medical record. She said they were working with staff and conducted re-education/in-serviced on resident's rights. During a telephone interview on 05/22/25 at 1:52 PM, LVN R said she was taking care of Resident #86 on 05/02/25. She said the resident refused care because she did not want to take a shower. She said the resident was soiled and had stool in her brief and she thought it was best to shower the resident instead of using wet wipes. She said the resident did have a right to refuse care; however, she did not want the resident to stay in her soiled brief and clothes because that could lead to a Urinary Tract Infection (inflammation of the bladder, caused by bacteria that enter the urinary tract and multiply) or skin breakdown. LVN R said she did not contact the RP because she thought it would be okay to shower the resident. She said she only notified the incoming nurse and the former administrator of Resident #86's refusal during morning meeting. LVN R was unable to provide a risk to the resident. During an interview on 05/22/25 at 5:10 PM, the Administrator said residents had a right to refuse. She said if the resident refused care, it was their right . Record review of the facility's, undated, policy and procedure titled, Statement of Resident Rights read in part . 10. Participate in developing a plan of care, to refuse treatment, and refuse to participate I experiment research FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676333 If continuation sheet Page 3 of 8 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676333 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Magnolia Crossing Nursing and Rehabilitation Cente 10800 Flora Mae Meadows Rd Houston, TX 77089 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to assess the resident for risk of entrapment from bed rails prior to installation, review the risks and benefits of bed rails with the resident or resident representative and obtain informed consent prior to installation for 3 of 6 Residents (Resident #95, Resident #64, and Resident #356,) reviewed for the use of side rails. The facility failed to ensure nursing staff obtained physician orders and consent for the use of side rails for Residents #95, #64 and #356. This failure could place residents at risk of injury, hinder residents from getting out of bed, and/or cause a decline in resident's ability to engage in activities of daily living. Findings include: 1. Record review of Resident #95's face sheet, dated 5/20/25, reflected an [AGE] year-old female who was admitted to the facility on [DATE]. Resident #95 had diagnoses which included unspecified trochanteric fracture of right femur (a fracture that occurs in the region of the trochanters, which are bony prominences on the thigh bone near the hip), unspecified dementia (a group of thinking and social symptoms that interferes with daily functioning), muscle wasting and atrophy (the wasting or thinning of muscle mass), muscle weakness, unsteadiness on feet, and history of falling. Record review of Resident #95's quarterly MDS assessment, dated 4/9/25, reflected she had a BIMS score of 2, which indicated severe cognitive impairment. Resident #95 required supervision or touching assistance with rolling left and right, from sitting to lying and from lying to sitting on side of bed. Record review of Resident #95's care plan, dated 4/22/25, did not reflected she used side rails. Record review of Resident #95's physician orders for May 2025 reflected there was not an order for the use of side rails. Record review of Resident #95's EHR under the miscellaneous section reflected there was not a consent form and no assessments for the use of side rails. Observation on 5/20/25 at 1:55 PM revealed Resident #95 was lying in bed; the call light was within reach. There were half-sized bed rails up in the middle of the bed on each side, the bed was in lowest position and fall mats where on both sides of the bed. Interview with Resident #95's family member on 5/22/25 at 2:37 PM, she said she could not remember if she signed a consent for bed rails. The Family Member said Resident #95 had the bed rails the entire time she had been in the facility. 2. Record review of Resident #64's face sheet, dated 5/21/25, reflected an [AGE] year-old female who was admitted to the facility on [DATE]. Resident #64 had diagnoses which included vascular dementia (caused by brain damage from impaired blood flow to the brain resulting in problems with, memory (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676333 If continuation sheet Page 4 of 8 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676333 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Magnolia Crossing Nursing and Rehabilitation Cente 10800 Flora Mae Meadows Rd Houston, TX 77089 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some and other thought processes), morbid obesity (a condition in which a person has a body mass index higher than 35) , cerebral infarction (occurs when blood flow to the brain is blocked, causing brain tissue to die), muscle wasting and atrophy (the wasting or thinning of muscle mass), and muscle weakness. Record review of Resident #64's quarter MDS assessment, dated 2/16/25, reflected she had a BIMS score of 11, which indicated moderate cognitive impairment. Resident #64 required partial/moderate assistance with rolling left and right, from sitting to lying and from lying to sitting on side of bed. Record review of Resident #64's care plan, dated 4/2/25, did not reflect she used side rails. Record review of Resident #64's physician orders for May 2025, reflected an order was added on 5/21/25 for resident to use ¼ length rails for bed mobility. Record review of Resident #64's EHR under the miscellaneous section reflected there was not a consent form and no assessments for the use of side rails . Observation on 5/21/25 at 5:00 PM revealed Resident #64 was lying in bed with the head of the bed raised. There were half-sized bed rails up in the middle of the bed on each side, and a fall mat in place. 3. Record review of Resident #356's face sheet, dated 5/22/25, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #356 had diagnoses which included vascular dementia ( caused by brain damage from impaired blood flow to the brain resulting in problems with, memory and other thought processes), Chronic Obstructive Pulmonary Disorder (lung disease that block airflow and make it difficult to breathe), and muscle wasting and atrophy (the wasting or thinning of muscle mass). Record review of Resident #356's Quarterly MDS Assessment, dated 2/03/25, did not document a BIMS for the resident. Resident #64 required substantial/maximal assistance with rolling left and right, from sitting to lying and from lying to sitting on side of bed. Record review of Resident #356's care plan, dated May 2025, did not reflect she used side rails. Record review of Resident #356's physician orders for May 2025 reflected an order was added on 5/22/25 to use bilateral 1/4 siderails to maintain the bed perimeter related to restless movement. Record review of Resident #356's electronic medical record reflected no signed consent and no assessments for bed rails . During an interview with the Interim DON on 5/21/25 at 1:51 PM, she said rail assessments were completed upon admission. The Interim DON said she was unsure why the assessments and consents were not completed. She said the nurses were responsible for the assessments and consents and the ADON and the DON looked behind the nurses to make sure assessments and consents were completed. The Interim DON said the facility switched to a different EHR system back in December and the assessments and consents were probably in the old EHR system . She said the risk to the resident when there are no orders in place for bed rails, could cause bruises or even a choking hazard. During an interview with LVN A on 5/21/25 at 5:14 PM, she said if she saw a resident who was able (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676333 If continuation sheet Page 5 of 8 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676333 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Magnolia Crossing Nursing and Rehabilitation Cente 10800 Flora Mae Meadows Rd Houston, TX 77089 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0700 Level of Harm - Minimal harm or potential for actual harm to use their arms but had trouble turning, she would discuss with the DON, family, and doctor for the recommendation of bed rails. LVN A said the assessment should come first, then the consent . She said the bed rails that were in the middle of the of the bed were used for residents who were considered a fall risk. She said the risk to the resident when they were not assessed for bed rails could be they could put their arms through the bed rail and get stuck. Residents Affected - Some During an interview with LVN B on 5/21/25 at 5:39 PM, she said bed rails were used for mobility. LVN B said, for example, if they provided incontinent care, the resident could hold onto the bed rail and roll over . LVN B said she did not know what the side rails located in the middle of the bed were used for. LVN B said there should be orders and assessments for bed rails, and they should be included in the care plan. LVN B said the purpose of the bed rails was for the resident to hold onto them while repositioning. She said bed rails were not to be used as a fall risk because it could be considered a restraint for the resident. During an interview with ADON A on 5/22/25 at 3:18 PM, she said bed rails should be used as assist bars, which were not normally located in the middle of the bed . There should be an order and consent for bed rails and the bed rails should be care planned. ADON A said bed rails should not be used as a restraint. She said the risk to the resident could lead to injury, trauma, or death. During an interview with the Administrator on 5/22/25 at 5:00 PM, she said if a resident needed a bed rail, the resident should have orders, and the bed rails could be included in the care plan. She said if PT recommended bed rails, they would include them in the care plan. The Administrator said the DON was responsible for obtaining consents and care planning the bed rails. She said bed rails for a resident were also reviewed in the clinical meetings. The administrator said the risk to the resident was a risk of falls. They could attempt to get out of bed and harm themselves getting across the bed rail. A policy for bed rails was requested from Interim DON on 5/22/25 at 3:45 pm and the Administrator on 5/22/25 at 5:00 PM, the facility did not have a policy for bed rails. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676333 If continuation sheet Page 6 of 8 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676333 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Magnolia Crossing Nursing and Rehabilitation Cente 10800 Flora Mae Meadows Rd Houston, TX 77089 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0790 Provide routine and 24-hour emergency dental care for each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to assist residents in obtaining routine and 24-hour emergency dental care for 1 of 6 residents (Resident #36) reviewed for dental services. Residents Affected - Few The facility failed to ensure Resident #36 was referred to the dentist after she complained of tooth pain. This failure could place residents at risk of pain and decline in health. Findings included: Record review of Resident #36's, undated, face sheet, reflected an [AGE] year-old female who was admitted to the facility on [DATE]. Her diagnoses included Congestive Heart Failure (Condition in which the heart does not pump blood as well as it should), Metabolic Encephalopathy (brain dysfunction resulting from disruption in the body's metabolism, leading to altered mental status and cognitive impairment), and Cerebral Infarction (Blood flow to the brain is blocked leading to tissue death). Record review of Resident #36's Quarterly MDS Assessment, dated 03/03/25, reflected she had a BIMS score of 14, which indicated that the resident was cognitively intact. Record review of Resident #36's nursing note dated 04/30/25 at 11:27 PM, reflected the resident had a complaint of dental pain to upper left jaw. Record review of Resident #36's nursing note dated 05/20/25 at 12:04 PM, reflected the resident had a complaint of tooth pain to the right side of mouth. Record review of Resident #36's nursing note dated 05/21/25 at 5:36 PM, reflected the social worker contacted an outside local dental group to set up an emergency appointment for the resident's complaint of tooth pain. During an interview and observation on 05/21/25 at 9:06 AM, Resident #36 said she had a toothache on the right side, and the staff had not addressed it. Pain medication was administered to the resident due to complaint of tooth pain . During an interview on 05/21/25 at 11:46 AM, the RP said her family member had a tooth abscess and had not seen a dentist since her initial complaint , which was several weeks prior. During an interview on 05/21/24 at 5:39 PM, LVN B said Resident #36 informed her she complained of tooth pain approximately 1 week ago. She said she assessed the resident, notified the RP, and administered pain medication. She said she gave the resident medication again today due to complaint of tooth pain. She said she assumed an order for dental services was already in place after speaking with the RP . She said the risk for not reporting tooth pain could lead to infection and/or sepsis. During an interview on 05/22/25 AM at 9:52 AM, the Social Worker said he started at the facility at the end of April and was not aware the resident needed urgent dental services. He said the 1st time he heard Resident #36 had dental concerns was when the state surveyor asked about it on 05/21/25 . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676333 If continuation sheet Page 7 of 8 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676333 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Magnolia Crossing Nursing and Rehabilitation Cente 10800 Flora Mae Meadows Rd Houston, TX 77089 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0790 Level of Harm - Minimal harm or potential for actual harm During an interview on 05/22/25 at 3:18 PM, the ADON said the resident with constant or recurring mouth pain should require an emergency dental service. She said her expectation was for the nurses to notify the doctor and work with the social worker to arrange a dental appointment. She said Resident #36's issue should have been addressed within 24 hours of the complaint. The ADON said untreated dental problems could lead to infection, which could cause illness. Residents Affected - Few During an interview on 05/22/25 at 5:00 PM, the Administrator said she was unaware of Resident #36 complaint of pain. She said the nurses should have assessed the resident and notified the social worker and the doctor for a dental consultation. She said she would notify the RP, and Resident #36 would be seen by the dentist at the next available appointment . During an interview on 05/22/25 at 5:30 PM, the DON said routine dental services were scheduled for Resident #36 in June. She said the resident had been eating without issues, and there was no change in weight, or food texture, or consumption. She said the risk of having a prolonged tooth abscess or infection could lead to complications, such as worsening of the infection or pain. Record review of the facility's Dental Services policy, dated 10/24/22, read in part, . It is the policy of this facility to assist resident in obtaining routine and emergency dental care. Emergency dental services includes services needed to treat an episode of acute pain in teeth, gums, or palate; broken, or otherwise damaged teeth, or any other problem of the oral cavity that required immediate attention by a dentist FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676333 If continuation sheet Page 8 of 8